A young woman consulted me because she found out almost simultaneously that she had AIDs and was pregnant. In the early days of AIDs this tragic diagnosis meant that she was looking at her own death and that it was nearly certain that her child also would be infected with the virus and die in infancy. She chose to terminate her pregnancy. Her long-time family physician refused to help her because, unbeknownst to her, his religious and moral views did not permit him to make a referral for, or participate in this procedure. She came to visit me quite distraught. Not only had she lost her physician, but she also did not know if I would help her. Patients deserve to know — before an urgent need arises — their doctor’s stance vis à vis common medical procedures which are not performed by all physicians because of ethical concerns.

By Renate G. Justin, MD

Many citizens will need to choose a primary care physician once the changes to our health care system take place later this year. In order to make an informed choice having certain information available would be helpful. Doctors’ specialties, where they went to medical school and where they did their residency are details easily obtained from the internet. The same source will yield office hours, e-mail, telephone numbers and address. The office receptionist will be able to tell the potential new patient whether the doctor shares after hour call with a colleague or expects patients to use urgent care and emergency rooms. The receptionist will also know which insurances the office accepts and whether all necessary papers will be filed.

If the outcome of the above inquiry is satisfactory, and you are the new patient, it would be a reasonable next step to make an appointment for a ‘get acquainted’ visit with the doctor. Because patients and doctors mistakenly assume that they hold the same views you, as a future patient, might want to explore some of the following topics at the time of this visit:

“Dr. Jones, if you suggest a treatment course and I decide not to follow your advice, what will your course of action be?”

“Will you tolerate my occasional use of alternative medicine therapies along with what you prescribe?”

“What are your views on organ donation?”

“If I should be terminally ill, on life support, but of sound mind, and would desire discontinuation of treatment, would you be able to help me?”

“Are you comfortable, Doctor Jones, treating patients of any type of sexual orientation?”

“Dr. Jones, if we profoundly disagree, how will we be able to resolve our difficulty?”

There may be other issues important to you and to your family’s future health care which you may want to bring up. Does Dr. Jones object to birth control for teen-agers and referral for termination of pregnancy? If genetic testing would become necessary, would Dr. Jones feel that the results would have to be shared with your family? What about stem cell therapy?

The tone and Dr. Jones’s receptiveness to the topics of this conversation will likely be a good prognostication of how your future relationship will develop.

It is important to be proactive, so that you know that you and your doctor can resolve these issues along with new ones that will arise in the future and affect your health care. If you decide to join Dr. Jones’s practice, you should keep this conversation current, because both doctors and patients will change their moral, their ethical convictions at times. Since a thriving doctor-patient relationship is built on mutual trust and respect it is important that both the doctor and the patient are aware of each others’ answers to these often difficult and divisive questions.

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